Weight should be taken through the hands through the hand pads when using crutches. For Underarm crutches, the top of the crutches should be pressed against the side of the chest wall (approximately 5 cm under the armpit). It is important that the crutches are not positioned high against the armpit, as this may cause damage to the nerves and blood vessels located close to the skin and may also affect posture, balance and stability. The crutches should be positioned slightly to the side and to the front of the body for a stable base of support.
1. Some weight bearings: There are many ways to use crutches depending on the balance and the ability to place weight on one or both legs. If the affected leg is able to hold somebody weight, it is recommended that the crutches and the affected leg be placed forward together for approximately one step (sharing the load between them) followed by the unaffected leg.
2. One-point walking pattern: the crutch and broken leg is one point and the leg that wasn't injured is the other point. The crutches and fractured limbs are advanced as one unit, and the uninvolved weight-bearing limb is brought forward to the crutches as the second unit. This gait pattern is less stable as only two points are in contact with the floor and a good balance is needed to walk with a 2-point crutch gait.
3. Three-point walking pattern: this gait pattern is used when one side of the lower extremity (LE) cannot bear weight (due to fracture, amputation, joint replacement etc). It involves three points of contact with the floor, the crutches serve as a single point, the involved leg as a second point, and the uninvolved leg as a third point. Each crutch and the weight-bearing limb are advanced separately, with two of the three points.
4. Four-point walking pattern: another option is to use a four-point walking pattern, which is slower but may help with safety due to general weakness. This involves putting one crutch forward, then the opposite leg, and then the next crutch forward, followed by the final leg, and continuing with this pattern.
- No weight-bearing: if the balance is poor and no weight can be taken on the affected leg, then it is suggested that both crutches should be put forward first, followed by a hop forward of the unaffected leg, stopping just behind the crutches and keeping the affected leg clear of the ground. If the balance is good, the hop can swing past the crutches, which will increase speed and fluency.
- Step climbing: To climb upstairs and steps, first lift the unaffected leg up to the step while taking weight on the crutches, and then take the crutches and the affected leg to the second step. To go down, lower the affected leg and lower the crutches first, followed by the unaffected leg second.